Provider Demographics
NPI:1164764239
Name:KUSHWAHA, KRISTIN (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:KUSHWAHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:NICOLE
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2406 BLUE RIDGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6692
Mailing Address - Country:US
Mailing Address - Phone:919-786-5001
Mailing Address - Fax:919-786-5051
Practice Address - Street 1:104 MEDSPRING DR STE 100
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-9687
Practice Address - Country:US
Practice Address - Phone:919-359-3500
Practice Address - Fax:919-359-3501
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013017006208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics